5 Family-Based Treatment Options Surprisingly few treatments for adolescent depression, let alone suicide, target family functioning. CBT prevention and treatment programs have added family psycho education modules. Little data to suggest this potentiates treatment. Beardslee developed a program to directly treat depressed parents and their children. Some very promising family-based prevention and treatment programs for adolescent substance abuse, delinquency and disruptive disorders and families experiencing divorce.

6 Family-Based Treatment Options There have been a few family-based intervention studies specifically for treating suicidal youth (e.g., Harrington et al., 1998 ; Huey et al., 2004). Some promising outcomes, but none had a strong theoretical basis for the treatment, were tailored to the specific needs of this population, or have been systematically investigated.

7 Why Family Treatment? Family as Protective Factor The family is the most potent developmental and protective context of child development (American Academy of Pediatrics, 2000). As with young children, a combination of parental warmth and monitoring are associated with better adolescent functioning, less suicide, and lower depression.

8 Family As Safety Net The goal is not to blame families, but to strengthen them Family as the medicine Improving communication and trust Provides a buffer against depression and suicide Increase parents ability to monitor safety Increase parents ability to serve as a resource for support

9 From an Attachment Perspective Children internalize beliefs about self and expectations of others through the early attachment relationships Some data suggest that parent child interactions influence, if not determine, the development of negative depressogenic cognitive thinking styles (e.g. self worth, hopelessness, etc). These become internal working models that influence how we see ourselves and what we expect from others.

10 From an Attachment Perspective Bowlby, Ainsworth and others proposed a life span attachment model. The transactions between interpersonal relationships and intra personal models of self and other, continues throughout life. If internal models are shaped by interpersonal relations, then can these models be revised if relationships improve?

12 A Transactional Model of Change Parent and adolescent s internal working model of self and other have been primed to be more receptive to new information and experiences. Engineer family conversations about core attachment ruptures. Adolescents are challenged to be more direct, honest, but regulated. Parents are challenged to be more receptive, curious, supportive, and non defensive. When adolescent are more mature and direct about their felt injustices, parents are more responsive and sensitive to their needs. As parents become more emotionally available, adolescents begin to revise their image of the parents as indifferent or unapproachable and see them as more helpful and trust worthy.

13 A Transactional Model of Change The ABFT therapist promotes both psychological change as well as interpersonal change and uses the transaction between these domains as leverage for therapeutic growth.

16 Task 1 : Relational Reframe Bond: Building Alliance Goal: Reframing the Problem/Solution Shifting from patient as problem to family relationships as solutions What gets in the way of you going to your mother for help when you are feeling so depressed? Puts burden of change on all family members Task: Establishing a Treatment Contract

18 Task 3: Building Alliance With the Parent Bond: Understanding current stressors and parent s own history of attachment failures. Goals: Empowering parents and getting a commitment from them to protect adolescent from another generation of abandonment. Task: Preparation for this conversation Learning emotional coaching skills

21 Goals of Attachment Task Trust and communication reemerge Family members feel more confident that they can work through difficult problems together Parents work more as a team Adolescent feels safe turning to parents for help

22 Task 5: Competency Promoting Build competency in communication skills between parents and adolescent. Re-engage adolescents in social world/activities Self esteem is seen as a buffer against stress Identify appropriate challenges Parent s are now viewed as a secure base and should be used to support the adolescent in building competency and set reasonable expectations.

23 Empirical Support ABFT has shown to be effective with depressed and or suicidal adolescents in 4 studies. Now classified as a proven practice by the Rand Corporation and soon to be approved by NREPP.

24 First study Open trial showed marked decrease in both depression and suicidal ideation in 15 adolescents.

25 Second Study NIMH funded small randomized clinical trial. 32 patients: ABFT or wait list control. Significant reductions in depression diagnosis (87% recover) and symptoms, suicidal ideation, and anxiety. Increase in family attachment. Published in Journal of the American Academy of Child and Adolescent Psychiatry.

26 Adolescent Suicide Every year 1 in 5 adolescents contemplates suicide, 5 to 8% attempt suicide and approximately 1,600 to 2,000 adolescents die by suicide. When you take into account non-lethal attempts, approximately one million teenagers attempt suicide each year.

27 Suicide Treatment and Prevention Research Less then 10 published studies on psychotherapy for suicidal youth. In many of the studies, experimental treatment does no better than Treatment As Usual in reducing suicide attempts or ideation. In many studies, there was no difference between experimental and control treatment. There are no psychopharmacology studies for suicidal youth and much controversy about its impact on suicidal ideation.

28 Third Study CDC funded randomized clinical trial. 66 adolescents randomized to ABFT or Enhanced Usual Care (EUC) 70% female, 80% African American 50% had previous attempts, 30% MDD, 80% Anxiety 50% reported a history of sexual abuse Published in Journal of the American Academy of Child and Adolescent Psychiatry.

32 Sexual Trauma and Response to Treatment Youth with sexual trauma history are more likely to have higher levels of suicidal ideation and attempts (Beautrais et al., 1996). Adolescents with sexual trauma history tend to have poorer responses to depression treatment. Barbe et al. (2004) CBT no more efficacious than non-directed supportive psychotherapy for those with sexual trauma history Lewis et al. (2010) CBT outcomes moderated by sexual trauma history but not physical abuse (TADS) Asarnow et al. (2009) youth with abuse history responded poorly to CBT + medication (TORDIA) Cannot assume findings from depression studies can be generalized to suicidal youth. No studies have examined sexual trauma history on treatment outcomes in suicidal youth.

33 Rate of Change on SSI History of Sexual Trauma No History of Sexual Trauma ABFT superior to EUC regardless of sexual trauma history Sexual trauma history did not moderate ABFT s effect on suicidal ideation No interactions over time

34 Rate of Change on BDI-II History of Sexual Trauma No History of Sexual Trauma ABFT superior to EUC from baseline to mid-treatment regardless of sexual trauma history; no differential outcomes at post-treatment and follow-up Greater early decline in youth without sexual trauma history Sexual trauma history did not moderate ABFT s effect on depressed mood No interactions over time

35 Dissemination Efforts Fourth Study in Norway with 20 adolescents showed: We can train therapists Treatment was more effective than treatment as usual for reducing major depression Training programs now in Australia, Belgium, Israel, Norway, Sweden, and Virginia

36 ABFT as Aftercare Few studies on treatment for adolescents post hospital after a suicide attempt. Majority of youth referred to treatment do not go or drop out prematurely (Daniel, 2004). With funding from AFSP, we randomized 20 adolescent to ABFT or treatment as usual. Small pilot sample to provide feasibility date.

37 Feasibility FINDINGS Families in ABFT were more satisfied with their treatment than their EUC counterparts. Families in ABFT started treatment sooner than their EUC counterparts. Outcome Adolescents in ABFT were significantly less likely to reattempt suicide. Adolescents in ABFT reported less attachment related avoidance towards their mother. Adolescents in ABFT reported less attachment related anxiety towards their father.

38 Comparison on Reattempts

39 ABFT for GLBT Adolescents Open trial, 10 GLB adolescents with severe suicidal ideation Phase I manual development more time with parents heighten parents' awareness of micro aggressions help families reduce or resolve parental non-acceptance Phase II treatment Average of 12 sessions completed Significant decrease in depressive symptoms and suicidal ideation from baseline to week 6 Decrease in attachment related anxiety from week 6 to end of treatment

40 Current Studies ABFT as an adjunct to adult individual psychotherapy ABFT verses None Directive Supportive Therapy (Brent and Kolko, 1997) for suicidal youth (5 year funding from NIMH, just funded). Using the Adult attachment Instrument and family interaction data to test Are internal working models of attachment and family interaction changing? Do these changes mediate symptom reduction?

SPECIALIST ARTICLE A BRIEF GUIDE TO PSYCHOLOGICAL THERAPIES Psychological therapies are increasingly viewed as an important part of both mental and physical healthcare, and there is a growing demand for

The influence of integrative play therapy on children Abstract Flora Lamçja (Zeqaj) European University of Tirana The integration of theory, technique and common factors in psychotherapy has gained prominence

Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

(DPSY 01) First Year Paper I GENERAL PSYCHOLOGY 1. Explain the definition and scope of psychology. 2. Explain the patterns of brain and behavior in human psychology? 3. Write about perceptual constancy

Module 4 Suicide Risk Assessment About 3% of adults (and a much higher percentage of youths) are entertaining thoughts of suicide at any given time; however, there is no certain way to predict who will

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder AACAP Official Action: OUTLINE OF PRACTICE PARAMETERS FOR THE ASSESSMENT AND TREATMENT OF CHILDREN, ADOLESCENTS, AND ADULTS WITH ADHD

Suicidality in Adolescents Cognitive Behavior Therapy for Suicide Prevention (CBT-SP): A New Treatment for Suicidal Adolescents Barbara Stanley, Ph.D. New York State Psychiatric Institute/ Department of

PhD. IN (Psychological and Educational Counseling) I. GENERAL RULES CONDITIONS: Plan Number 2012 1. This plan conforms to the regulations of the general frame of the programs of graduate studies. 2. Areas

Workforce Development Online Workshop Descriptions Behavioral Health Service Delivery Workshops: The Effects of Violence Exposure on Children (1.5 hours) Regretfully, violence against children and youth

Depression and its Treatment in Older Adults Gregory A. Hinrichsen, Ph.D. Geropsychologist New York City What is Depression? Everyday use of the word Clinically significant depressive symptoms : more severe,

I. Introduction Division of Child and Family Services Treatment Plan Goal Status Review Aggregate Report The more efficient and effective the delivery of our services, the greater our opportunity for realizing

Caring For The Person Who Is Suicidal For further information see also the following MIND Essentials resource Conducting a suicide risk assessment. Suicidal thoughts and behaviours are not unique to mental

Course Descriptions: M.A. in Clinical- Community Psychology PSYC 501 Theories of Psychotherapy This course will offer in- depth discussion on the historical, philosophical and theoretical foundations of

Open Residential Firesetting and Sexual Behavior Treatment Program ABRAXAS Open Residential Firesetting and Sexual Behavior Treatment Program Since 2006, the Abraxas Open Residential Firesetting and Sexual

Case Formulation in Cognitive-Behavioral Therapy What is Case Formulation? A set of hypotheses regarding what variables serve as causes, triggers, or maintaining factors for a person s problems Description

Protection of the Rights of Children and Women Suffering from Drug Addiction in the Family and Society - Shelter Don Bosco, Mumbai, India - Article 24 of the Convention on the Rights of the Child recognizes

Social and Emotional Wellbeing A Guide for Children s Services Educators Social and emotional wellbeing may also be called mental health, which is different from mental illness. Mental health is our capacity

Psychopathology Change in the way look at problems. Similar to change in biology. Also look over life cycle. Look at how they adapt to change. 1 Burden Stages of research Diagnosable symptomatology Positive

Day Programs General Information Day Programs at the Melbourne Clinic (TMC) offer therapy treatment to people with a range of psychiatric conditions. The programs are evidence based and are facilitated

FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking

Treatment Description Acronym (abbreviation) for intervention: CPP Average length/number of sessions: 50 Aspects of culture or group experiences that are addressed (e.g., faith/spiritual component, transportation

TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than

The Incredible Years Program Series: Evaluation Methods Parenting Program Claims Evaluation Methods Evidence of Efficacy 4-8 year old children diagnosed with conduct problems whose parents received The

SUICIDAL BEHAVIOR IN CHILDREN AND ADOLESCENTS NADINE J KASLOW, PHD, ABPP NKASLOW@EMORY.EDU 2014 APA PRESIDENT Setting the Stage What are the common myths about suicide in children and adolescents? If I

Humanistic Experiential Psychotherapies (HEPs) for Depression: Evidence and Effective Practice Robert Elliott University of Strathclyde Depression: General Perspectives Together with substance abuse, the

Part II: Acceptance-Based Behavior Therapy for Depression and Social Anxiety Kristy Dalrymple,, Ph.D. Alpert Medical School of Brown University & Rhode Island Hospital Third World Conference on ACT, RFT,

What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

Bipolar Disorder: Advances in Psychotherapy Questions from chapter 1 1) Which is characterized by one or more major depressive episodes with at least one hypomanic episode in which the patient s functioning

Heartland and Alliance Professional Development Institute June 28, 2013 As many as 10 percent of our nation s population of children ages 0-5 have clinically significant social-emotional challenges. As

A Guide to Accessing Ser vices for Borderline Personality Disorder in Victoria ABOUT THIS GUIDE: WHAT IS Borderline Personality Disorder (BPD)? This guide refers to the National Health and Medical Research

Fixing Mental Health Care in America A National Call for Measurement Based Care in Behavioral Health and Primary Care An Issue Brief Released by The Kennedy Forum Prepared by: John Fortney PhD, Rebecca

Introduction Eating Disorders are described as severe disturbances in eating behavior which manifest as refusal to maintain a minimally normal body weight (Anorexia Nervosa) or repeated episodes of binge

Co Occurring Disorders and the on Children: Effectively Working with Families Affected by Substance Abuse and Mental Illness Definition (Co-Occurring also called Dual Dx) A professional diagnosis of addictive/substance

What are Cognitive and/or Behavioural Psychotherapies? Paper prepared for a UKCP/BACP mapping psychotherapy exercise Katy Grazebrook, Anne Garland and the Board of BABCP July 2005 Overview Cognitive and

Student 4M 1 Student 4M ENGL 1007.001 Mr. McCarty February 12, 2014 Cures for Everything With all the new technology that we have come across in these past years has there been a discovery to cure borderline

Mood CRS Formulation Depression The word depression is used to describe a variety of states ranging from normal unhappiness after a loss up to severe major depressive illness with physical and psychotic

Anti-Social Personality Disorder Definition Anti-Social Personality Disorder is a type of chronic mental condition in which a person's ways of thinking, perceiving situations and relating to others are

Questions and Answers about Child Sexual Abuse Treatment An Interview with Judith Cohen, MD Dr. Judith Cohen is a member of the and Medical Director of the Center for Traumatic Stress in Children, Department

RUTGERS SCHOOL PSYCHOLOGY PROGRAM PRACTICUM HANDBOOK Introduction School Psychology is a general practice and health service provider specialty of professional psychology that is concerned with the science

Trauma and the Family: Listening and learning from families impacted by psychological trauma Focus Group Report A summary of reflections and remarks made by Baltimore City families impacted by trauma and

AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year Non-profit mental health agency established in 1945 Recipient of the CAMFT School and Agency Award for 2009 Clients from diverse

Screening Tools and Interventions for Common Behavioral Health Disorders TXPEC-0772-13 Screening Tools and Interventions for Common Behavioral Health Disorders Depression Depression is a potentially life-threatening

Depression and Anxiety in Adolescence Andy Lovett Director of Paediatrics Learning objectives Understand the scope and presentation of depression and anxiety in adolescence Refresh the skills in history

New findings on Borderline Personality Disorder : a research update Associate Professor Brin Grenyer University of Wollongong grenyer@uow.edu.au 1 Today What is new - hot topics and studies 2008-9 Current

CSL 501 Evaluation and Assessment This course is designed to provide students with an understanding of individual, couple, family, group and environmental/community approaches to assessment and evaluation.

A Definition of Motivational Interviewing The definition of Motivational Interviewing (MI) has evolved and been refined since the original publications on its utility as an approach to behavior change.